Abstract
We carried out MRI on 43 survivors of childhood cancer after different treatment protocols with or without cranial radiotherapy. They were free of disease, therapy having been discontinued 2–20 years earlier. Treatment had been for various malignancies, excluding brain tumours; 27 had received cranial irradiation for acute lymphoblastic leukaemia (ALL) or lymphoma. Two asymptomatic young women treated for ALL had falx meningiomas. White matter changes, low intensity foci (representing calcification or old haemorrhage) and heterogeneous intensity focic old haemorrhages) were seen only in patients who had undergone radiotherapy. Because of the possibility of benign, potentially curable brain tumours occurring after cranial irradiation, it may be wise to carry out occasional cranial imaging in the follow-up of these patients. No routine imaging follow-up is needed after chemotherapy alone.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ochs JJ (1989) Neurotoxicity due to central nervous system therapy for childhood leukemia. Am J Pediatr Hematol Oncol 11: 93–105
Pääkkö E, Vainionpää L, Lanning M, Laitinen J, Pyhtinen J (1992) White matter changes in children treated for acute lymphoblastic leukemia. Cancer 70: 2728–2733
Peylan-Ramu N, Poplack DG, Pizzo PA, Adornato BT, Di Chiro G (1978) Abnormal CT scans of the brain in asymptomatic children with acute lymphocytic leukemia after prophylactic treatment of the central nervous system with radiation and intrathecal chemotherapy. N Engl J Med 298: 815–818
Vainionpää L, Laitinen J, Lanning M (1992) Cranial computed tomographic findings in children with newly diagnosed acute lymphoblastic leukemia: a prospective follow-up study during treatment. Med Ped Oncol 20: 273–278
Nygaard R, Garwicz S, Haldorsen T, Hertz H, Jonmundsson GK, Lanning M, Moe PJ (1991) Second malignant neoplasms in patients treated for childhood leukemia. Acta Paediatr Scand 80: 1220–1228
Hawkins MM, Draper GJ, Kingston JE (1987) Incidence of second primary tumors among childhood cancer survivors. Br J Cancer 56: 339–347
De Angelis LM, Shapiro WR (1991) Drug/radiation interactions and central nervous system injury. In: Gutin PH, Leibel SA, Sheline GE, eds. Radiation injury to the nervous system. Raven Press, New York, pp 361–382
Asato R, Akiyama Y, Ito M, Kubota M, Okumura R, Miki Y, Konishi J, Mikawa H (1992) Nuclear magnetic resonance abnormalities of the cerebral white matter in children with acute lymphoblastic leukemia and malignant lymphoma during and after central nervous system prophylactic treatment with intrathecal methotrexate. Cancer 70: 1997–2004
Ebner F, Ranner G, Slavc I, Urban Ch, Kleinert R, Radner H, Einspieler R, Justich E (1989) MR findings in methotrexate-induced CNS abnormalities. AJNR 10: 959–964
Pääkkö E, Talvensaari K, Pyhtinen J, Lanning M (1994) Decreased pituitary gland height after radiation treatment to the hypothalamic-pituitary axis evaluated by MR. AJNR 15: 537–541
Rubinstein AB, Shalit MN, Cohen ML, Zandbandk U, Reichenthal E (1984) Radiation-induced cerebral meningioma: a recognizable entitity. J Neurosurg 61: 966–971
Ghim TT, Seo JJ, O'Brien M, Meacham L, Crocker I, Krawiecki N (1993) Childhood intracranial meningiomas after high-dose irradiation. Cancer 71: 4091–4095
Potish RA, Dehner LP, Haselow RE, Kim TH, Levitt SH, Nesbit M (1985) The incidence of second neoplasms following megavoltage radiation for pediatric tumors. Cancer 56: 1534–1537
Moss SD, Rockswold GL, Chou SN, Yock D, Berger MS (1988) Radiation-induced meningiomas in pediatric patients. Neurosurgery 22: 758–761
Tiberin P, Maor E, Zaizov R, Cohen IJ, Hirsch M, Yosefovich T, Ronen J, Goldstein J (1984) Brain sarcoma of meningeal origin after cranial irradiation in childhood acute lymphocytic leukemia. J Neurosurg 61: 772–776
Crooks GM, Baron-Hay GS, Byrne GC, Cameron FG, Hookings P, Keogh EJ, MacKellar A, Price PJS, Stuckey BGA, Campbell SA, Willoughby MLN (1991) Late effects of childhood malignancies seen in Western Australia. Am J Pediatr Hematol Oncol 13: 442–449
Meadows AT, Baum E, Fossati-Bellani F, Green D, Jenkin RDT, Marsden B, Nesbit M, Newton W, Oberlin O, Sallan SG, Siegel S, Strong LC, Voute PA (1985) Second malignant neoplasms in children: an update from the late effects study group. J Clin Oncol 3: 532–538
Soffer D, Pittaluga S, Feiner M, Beller AJ (1983) Intracranial meningiomas following low-dose irradiation to the head. J Neurosurg 59: 1048–1053
Wilson DA, Nitschke R, Bowman RE, Chaffin MJ, Sexauer CL, Prince JR (1991) Transient white matter changes on MR images in children undergoing chemotherapy for acute lymphocytic leukemia: correlation with neuropsychological deficiencies. Radiology 180: 205–209
Kingma A, Mooyaart EL, Kamps WA, Nieuwenhuizen P, Wilmink JT (1993) Magnetic resonance imaging of the brain and neuropsychological evaluation in children treated for acute lymphoblastic leukemia at a young age. Am J Pediatr Hematol Oncol 15: 231–238
Barkovich AJ, Kjos BO, Jackson DE, Norman D (1988) Normal maturation of the neonatal and infant brain: MR imaging at 1.5 T. Radiology 166: 173–180
Flodmark O, Roland EH, Hill A, Whitfield MF (1987) Periventricular leukomalacia: Radiologic diagnosis. Radiology 162: 119–124
Price RA, Birdwell DA (1978) The central nervous system in childhood leukemia. III. Mineralizing microangiopathy and dystrophic calcification. Cancer 42: 717–728
Priest JR, Ramsay NKC, Latchaw RE, Lockman LA, Hasegawa DK, Coates TD, Coccia PF, Edson JR, Nesbit ME Jr, Krivit W (1980) Thrombotic and hemorrhagic strokes complicating early therapy for childhood acute lymphoblastic leukemia. Cancer 46: 1548–1554
Ott N, Ramsay NKC, Priest JR, Lipton M, Pui CH, Steinherz P, Nesbit ME (1988) Sequelae of thrombotic or hemorrhagic complications following L-asparginase therapy for childhood lymphoblastic leukemia. Am J Pediatr Hematol Oncol 10: 191–195
Vaughn DJ, Jarvik JG, Hackney D, Peters S, Stadtmauer EA (1993) High-dose cytarabine neurotoxicity: MR findings during the acute phase. AJNR 14: 1014–1016
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Pääkkö, E., Talvensaari, K., Pyhtinen, J. et al. Late cranial MRI after cranial irradiation in survivors of childhood cancer. Neuroradiology 36, 652–655 (1994). https://doi.org/10.1007/BF00600433
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00600433